title: Combined optical coherence tomography and endobronchial ultrasonography for laser-assisted treatment of postintubation laryngotracheal stenosis.
abstract: OBJECTIVE
  We describe the use of combined optical coherence tomography (OCT) and endobronchial ultrasonography (EBUS) to identify the residual hypertrophic tissues and persistent inflammation that are known contributors to stricture recurrence after laser-assisted mechanical dilation (LAMD) oflaryngotracheal stenosis (LTS).
  
  
  METHODS
  Commercially available high-frequency EBUS (approximately 100-microm resolution) and time-domain OCT (approximately 10- to 20-microm resolution) systems were used to visualize airway wall microstructures in the area of hypertrophic tissue formation before and after LAMD in 2 patients with complex circumferential postintubation LTS.
  
  
  RESULTS
  Before LAMD, EBUS revealed a homogeneous layer consistent with hypertrophic tissue overlying a hyperechogenic layer corresponding to tracheal cartilage. OCT revealed a homogeneous light backscattering layer and an absence of layered microstructures within hypertrophic tissue. Immediately after LAMD, OCT of the laser-charred tissue showed high backscattering and shadowing artifacts; OCT of noncharred tissue showed bright light backscattering regions that suggested acute inflammation. EBUS revealed thinner but persistent hypertrophic tissue overlying the cartilage. Stenosis recurred in both patients.
  
  
  CONCLUSIONS
  Intraoperative use of EBUS and OCT could potentially identify residual hypertrophic tissues and persistent inflammation during or after LAMD. It might help physicians predict stricture recurrence, prompting alternative therapeutic strategies and avoidance of repeated endoscopic treatments for LTS.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of California, Irvine, Orange, California, USA.
authors.forename: Septimiu D
authors.initials: SD
authors.lastname: Murgu
authors.forename: Henri G
authors.initials: HG
authors.lastname: Colt
mesh_terms: D004106:Dilatation / Q000379:methods*; D019160:Endosonography; D006801:Humans; D006984:Hypertrophy; D007442:Intubation, Intratracheal; D007829:Laryngostenosis / Q000473:pathology / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods*; D055502:Secondary Prevention; D041623:Tomography, Optical Coherence; D014135:Tracheal Stenosis / Q000473:pathology / Q000601:surgery*